4123-17-13
Employer application for workers' compensation coverage.

(A)
To institute workers' compensation coverage under this
rule, the employer shall submit an application for coverage that completely
provides all the information required for the bureau of workers' compensation
to establish coverage for the employer.

(1)
The application
for coverage shall be submitted on a form designated by the bureau, and shall
include, at a minimum, the following information:

(c)
The federal tax
identification number or social security number of the
employer;

(d)
Information related to the description of the
employer's operations, including:

(i)
A description of the work done or industry conducted
by the employer, and

(ii)
The estimated average number of employees in each kind
of work; and

(iii)
The estimated wages of employees in each kind of work
over the next twelve months.

(e)
Information
related to whether the applicant for coverage has purchased an existing
business or has another associated policy;

(f)
Name of the
owners or corporate officers, and, where applicable for elective coverage, the
name and necessary identifying information of the sole proprietor, partners, or
ministers;

(g)
Signature of the person completing the application for
coverage; and

(h)
A non-refundable application fee equal to the minimum
administrative annual charge set forth in rule
4123-17-26
of the Administrative Code.

(2)
If the bureau
receives an application for coverage that does not contain all of the
information required by paragraph (A)(1) of this rule, the bureau will attempt
to contact the employer to obtain the required information. If the applicant
does not provide the required information, the bureau shall deny the employer's
application for coverage based upon the employer's failure to provide all the
information required by paragraph (A)(1) of this rule.

(3)
When an
applicant fails to provide the information required by paragraph (A)(1) of this
rule and has employed one or more persons, the employer may be considered a
non-complying employer under rule
4123-14-01
of the Administrative Code, and the bureau may recover premium and penalties
from the employer under rule
4123-14-02
of the Administrative Code.

(B)
Upon receipt of
the application, the bureau shall assign payroll to the classification
applicable to the duties performed. The bureau shall send the employer notice
of its determination regarding the employer's manual classifications and
division of the employer's payroll within those classifications, the manual
rates for those classifications, and estimated premium due for the remainder of
the policy year in which the employer applies for initial
coverage.

(C)
If the bureau determines, after reviewing the
information submitted with the application provided for in paragraph (A) of
this rule, that the employer was subject to division (B)(2) of section
4123.01
of the Revised Code but failed to comply with the law in matters of workers'
compensation coverage, the bureau shall notify the employer in writing of such
a finding and request any additional information required to make a
determination of the period for which the employer was not in compliance with
the law. Upon such determination, the bureau shall notify the employer of the
premium and assessments due for the period of noncompliance.

(D)
If the bureau
determines, after reviewing the information submitted with the application
provided for in paragraph (A) of this rule, that the employer is essentially
the same employer regardless of entity type for which risk coverage previously
had been provided, the bureau may transfer the prior risk coverage to the
employer pursuant to rule
4123-17-02
of the Administrative Code and the employer shall assume any outstanding
obligations under the prior risk coverage. The bureau may reactivate a
previously cancelled policy in order to complete this transfer.

(E)
Upon receipt of
the application fee, the bureau shall issue a notice of workers' compensation
coverage pursuant to section
4123.82
of the Revised Code. The notice shall indicate that coverage is contingent on
payment of estimated premium and assessments due.

(F)
Upon receipt of
the first estimated premium payment, the employer's coverage shall begin.

(1)
Such coverage
shall be effective from the date of receipt of the application for coverage
required by paragraph (A) of this rule.

(2)
A credit in an
amount equal to the application fee shall be applied to the employer's account
upon receipt of the first estimated premium payment.